Abstract :
Presence of intraosseous gas in absence of any obvious fracture or history of surgery specially if present in extra-axial
skeleton suggest emphysematous osteomyelitis. Though rare it is a serious infection which needs immediate diagnosis and
prompt treatment. The organisms usually causing emphysematous osteomyelitis include staphylococcus, streptococcus,
klebsiella, E.coli and sometimes Mycobacterium tuberculosis. In some cases the cause may be polymicrobial. The
radiological differential diagnoses of emphysematous osteomyelitis include trauma, post-surgical change, degenerative
diseases, osteonecrosis, post-biopsy and malignant bone lesions. The patients having immunodeficiency are prone to
develop emphysematous osteomyelitis. The mechanism of infection is usually hematogenous spread. In rare instances it
may spread from a local infection like from skin or soft tissue. The diagnosis of emphysematous osteomyelitis depends
upon constitutional symptoms like fever, malaise, leukocytosis and presence of intraosseous air. In some cases
surrounding soft tissue may also show presence of gas. CT scan can depict presence of intraosseous air more precisely. It
may also show presence of any adjacent abcesses. Early diagnosis and immediate treatment is required and antibiotics
should not be withheld even if microbiology culture and sensitivity reports are awaited. We report here a case of
emphysematous osteomyelitis caused predominantly by Group B streptococci. The imaging findings of intraosseous gas in
Head of femur, humerus, iliac bone and vertebral bodies on computed tomography aided in early diagnosis and treatment.
Keyword :
Emphysematous osteomyelitis, Imaging features, Computed Tomography, Antibiotics.